The North American Spine Society developed coverage recommendations for coccygectomy, electrical stimulation for bone healing and facet joint interventions; the society is now offering a 30-day comment period on the recommendations.
The coccygectomy recommendation includes coccyx removal to alleviate pain from the coccyx or sacrococcygeal joint when the patient's pain persists after six months of nonoperative treatment including specific treatment measures; when symptoms are indicated by local tenderness with the external palpation or intestinal palpation of the distal tip; and when there isn't any other known pain generator.
NASS recommends against surgery when there are other known pain generators; for sacrum or coccyx tumors or infections; and if active significant psychiatric disorders are present.
Click here to read the full recommendation and rationale.
The recommendations for electrical stimulation for spinal fusion healing are indicated for several reasons, including augmenting spinal fusion in any spinal region in specific patients and in high-risk patients. The treatment isn't indicated by the recommendations as the primary cervical or thoracic fusions; without high risk factors; or adjacent to primary bone healing of a spinal fracture, among other situations.
Click here to read the full recommendation and rationale.
The facet joint interventions cover diagnostic medial branch blocks, therapeutic medial branch blocks, diagnostic intraarticular zygapophyseal joint injections, therapeutic intraarticular zygapophyseal joint injections and therapeutic medial branch radiofrequency neurotomy.
Click here to read the full recommendations and rationale.